Healthcare Provider Details

I. General information

NPI: 1215383815
Provider Name (Legal Business Name): RACHEL GRINNAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKLYN AVE STE 201
SAN ANTONIO TX
78212-4802
US

IV. Provider business mailing address

2210 CASTELLO WAY
SAN ANTONIO TX
78259-2202
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-9800
  • Fax: 210-281-1001
Mailing address:
  • Phone: 434-258-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberU5113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: